Sendoso Benefit Guide

BENEFITS GUIDE An overview of the wide array of benefits provided by Sendoso , to help you enjoy increased well-being and financial security

PREPARED BY BRIO BENEFITS FOR SENDOSO

TABLE OF CONTENTS

 Introduction

4 6

 Medical Benefits  Dental Benefits  Vision Benefits  Life Insurance  Disability Insurance

11 13 15 17 20 21 23 24 25 26 27 28 38 43 45

 Health Savings Account (HSA)  Flexible Spending Account (FSA)

 Rocket Lawyer

 Classpass

 Financial Wellness

 Pet Insurance

 Cocoon

 Legal Notices

 Legal Notices - COBRA  Legal Notices - FMLA

 Notes Page

TABLE OF CONTENTS I

SENDOSO BENEFITS GUIDE

WE’VE GOT YOU COVERED Sendoso is proud to offer a comprehensive benefits package for you and your family. This program is designed to take great care of you when you need it. Make sure to explore your options to help you make the selections that best meet your needs.

INTRO & OVERVIEW

INTRODUCTION

For the 2024 plan year, Sendoso has worked hard to offer a competitive total rewards package that includes valuable and competitive benefits plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Sendoso is offering an overall benefits package that can be shaped and molded by you to fit your needs. As an employee of Sendoso enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization. This benefits booklet is a summary description of your Sendoso benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.

We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.

INTRODUCTION I

SENDOSO BENEFITS GUIDE

MEDICAL

MEDICAL PLAN

SUMMARY OF COVERAGE

PLAN NAME

HDHP

BASE

MID

BUY UP

In Network Coverage Deductible (Individual / Family) Out-of-Pocket Max Primary Care Visit Specialist Visit Coinsurance

$2,500 / $5,000

$1,000 / $2,000

$500 / $1,000

Plan pays 80% Plan pays 90% Plan pays 100% Plan pays 100%

$5,000 / $7,500

$2,000 / $4,000

$5,000 / $10,000

$1,000 / $2,000

20% after Deductible 20% after Deductible

$20 Copay $50 Copay

$25 Copay $50 Copay

$20 Copay $40 Copay

Telemedicine (MDLIVE)

20% after Deductible $20 or $50 Copay $25 or $50 Copay $20 or $40 Copay Outpatient Procedure 20% after Deductible 10% after Deductible 0% after Deductible 0% after Deductible Inpatient Visit 20% after Deductible 10% after Deductible 0% after Deductible 0% after Deductible Emergency Room 20% after Deductible $100 then 10% $100 Copay $100 Copay Urgent Care 20% after Deductible $55 then 10% $50 Copay $45 Copay Pharmacy (Retail - 30 day) 20% after Deductible $10 / $35 / $50 $15 / $35 / $50 $10 / $25 / $50 Out of Network Coverage Deductibles N/A $5,000 / $10,000 $1,000 / $2,000 $1,000 / $2,000 Coinsurance N/A Plan pays 50% Plan pays 60% Plan pays 60% Out-of-Pocket Max N/A $10,000 / $20,000 $8,000 / $16,000 $8,000 / $16,000

MEDICAL PLAN I

SENDOSO BENEFITS GUIDE

MEDICAL PLAN

SUMMARY OF COVERAGE

PLAN NAME

HMO HMO

Plan Type

In Network Coverage Deductible Out-of-Pocket Max Primary Care Visit Specialist Visit Outpatient Procedure Coinsurance

$0 / $0

Plan pays 100% $1,500 / $3,000

$15 Copay $15 Copay

$100 per procedure

Inpatient Visit

$250 per admit $100 per visit $15 per visit $10 / $20 / $20

Emergency Room

Urgent Care

Pharmacy (Retail - 30 day) Out of Network Coverage Deductibles

Coinsurance Out-of-Pocket Max

N/A

MEDICAL PLAN I

SENDOSO BENEFITS GUIDE

MEDICAL PLAN

KEY TERMS TO REMEMBER

ANNUAL DEDUCTIBLE

OUT-OF POCKET MAXIMUM

The amount you have to pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).

This is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out- of-pocket maximum, including expenses paid to the annual deductible*, copays and coinsurance *Except for Grandfathered medical plans

COPAYS AND COINSURANCE

PLAN TYPES

• EPO/PPO – A network of doctors, hospitals, and other health care providers • HMO – A network that requires you to select a Primary Care Physician (PCP) who coordinates your health care • POS – Combines aspects of a PPO and HMO • HDHP – A plan that has higher annual deductibles in exchange for lower premiums.

These expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount, and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service, and is generally billed to you after the health insurance company reconciles the bill with the providers.

MEDICAL PLAN I

SENDOSO BENEFITS GUIDE

MEDICAL PLAN

Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Sendoso, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.

WHICH PREVENTIVE CARE SERVICES ARE COVERED?

The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:

“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE”

• Routine Physical Exam • Well Baby and Child Care • Well Woman Visits • Immunizations • Routine Bone Density Test • Routine Breast Exam • Routine Gynecological Exam • Screening for Gestational Diabetes • Obesity Screening and Counseling • Routine Digital Rectal Exam • Routine Colonoscopy

• Routine Colorectal Cancer Screening • Routine Prostate Test

• Routine Lab Procedures • Routine Mammograms • Routine Pap Smear • Smoking Cessation Programs

• Health Education/Counseling Services • Health Counseling for STDs and HIV • Testing for HPV and HIV • Screening and Counseling for Domestic Violence

MEDICAL PLAN I

SENDOSO BENEFITS GUIDE

DENTAL

DENTAL PLANS

SUMMARY OF COVERAGE

LOW PLAN

HIGH PLAN

Out-of- Network

Benefits

In-Network

Out-of-Network

Individual Deductible Preventive

$50

100%

Basic Major

90% 60% 50%

80% 50% 50%

80% 50%

Orthodontia

$1,500 Per Individual Plus Rollover

Annual Maximum

$5,000

$2,000

Orthodontia Maximum (Lifetime)

$1,000

$2,000

DENTAL PLAN I

SENDOSO BENEFITS GUIDE

VISION

VISION PLAN

SUMMARY OF COVERAGE

VSP

Benefits

In-Network

Out-of-Network

Frequency

Exam

Covered 100%

Up to $50

Every 12 Months

Lenses - Single Vision

Single Vision – Up to $48 Bifocal – Up to $67 Trifocal – Up to $86

$25 Copay

Every 12 Months

- Bifocal - Trifocal

Covered at 80% up to $200

Frames

Up to $48

Every 12 Months

Contacts (Medically Necessary) Contacts (Elective) (In lieu of lenses)

Coveredat 100%

Up to $210

Every 12 Months

$135 Allowance

Up to $130

Every 12 Months

• Note: If you enroll your domestic partner or domestic partner’s child(ren), you will be taxed on imputed income.

VISION PLAN I

SENDOSO BENEFITS GUIDE

LIFE

SUMMARY OF COVERAGE

Employer-paid Basic Life Insurance Plan Features

Supplemental / Voluntary Term Life Insurance Plan Features

Employees can choose different amounts of coverage between the minimum and maximum benefit amount. In increments of $10,000.

Employee Benefit Amount

$75,000

Employee Benefit Amount

Maximum Benefit Amount

$75,000

Minimum Benefit Amount

$10,000

AD&D Benefit

$75.000

Maximum Benefit Amount

$500,000

The following shows how much benefits are reduced at certain ages:

Guarantee Issue Maximum

$300,000 if under age 65

Age Band

Benefit Reduction

You may purchase in $5,000 increments up to a $250,000 maximum. Guarantee Issue is up to $25,000 if under age 65

60%

Spouse Benefit

Dependent Benefit You may purchase in $1,000 increments to a maximum benefit of $10,000. The following shows how much benefits are reduced at certain ages:

Age Band

Benefit Reduction

60%

LIFE INSURANCE I

SENDOSO BENEFITS GUIDE

DISABILITY

DISABILITY PLANS

SUMMARY OF COVERAGE

Sendoso Paid Plan Features

Short Term Disability

Employee Benefit Amount

60% of weekly salary

Maximum Benefit Amount

$2,500 per week

Elimination Period (Injury or Sickness)

7 days

Benefit Duration

13 Weeks

Sendoso Paid Plan Features

Long Term Disability

Employee Benefit Amount

60% of monthly salary

Maximum Benefit Amount

$12,000 per month

Elimination Period (Injury or Sickness)

90 days

Benefit Duration

Social Security Normal Retirement Age

DISABILITY – SHORT TERM I

SENDOSO BENEFITS GUIDE

ACCOUNT BASED HEALTH PLANS

HEALTH SAVINGS ACCOUNT (HSA) A Health Savings Account (HSA) is a health care account and savings account in one. It is only available on the Core Plan. The main purpose of this account is to offset the cost of a qualifying high deductible health plan (HDHP) and provide savings for your out-of-pocket eligible health care expenses – those you and your tax dependents may have now, in the future, and during your retirement. This is a “portable” account. You own your HSA! It’s included in your employee benefits package, but after you set up your account, it’s yours to keep, even if you change jobs or retire. Once your HSA is established, money is contributed to your account by you, the company, or friends and family, and you can then use your HSA dollars tax-free to pay for eligible health care expenses. You save money on expenses you are already paying for, like doctor’s office visits, prescription drugs, and much more. Best of all, you decide how and when to use your HSA dollars.

HIGHLIGHTS OF AN HSA

Your money can earn interest and you may choose from investment options

Contributions from payroll to the HSA are voluntary and made pre-tax

An individually owned bank account (you own it)

A Health Savings Account (HSA) allows you to reduce your taxable income and save for eligible healthcare expenses

The IRS limits the total annual amount you can deposit. For 2024- $4,150 for employee-only coverage or $8,300 for those covering dependents on the HDHP

Unused funds roll over from year to year, no use-it-or- lose-it

Refer to your HSA documentation for more information.

SENDOSO BENEFITS GUIDE

HSA I

FLEXIBLE SPENDING ACCOUNT (FSA)

Sendoso is offering a Flexible Spending Account (FSA) for 2024. This is how an FSA works: • You set aside money for your FSA from your paycheck before taxes are taken out. • Then use your pre-tax FSA funds throughout the plan year to pay for eligible health care or dependent care expenses. • You save money on expenses you’re already paying for.

You may also be able to carry over up to $640 of unused funds to the following plan year. Refer to your FSA documentation for more details.

DEPENDENT CARE FSA ELIGIBLE EXPENSES

HEALTH FSA ELIGIBLE EXPENSES

• Medical expenses: co-pays, co-insurance, and deductibles • Dental expenses: exams, cleanings, X- rays, and braces • Vision expenses: exams, contact lenses and supplies, eyeglasses, and laser eye surgery • Professional services: physical therapy,

• Care for your child who is under age 13 • Before and after-school care • Baby sitting and nanny expenses • Day care, nursery school, and preschool • Summer day camp • Care for a relative who is physically or mentally incapable of self-care and lives in your home

chiropractor, and acupuncture • Prescription drugs and insulin

• Over-the-counter health care items: bandages, pregnancy test kits, blood pressure monitors, etc.

Refer to your FSA documentation for more information.

FSA I

SENDOSO BENEFITS GUIDE

ADDITIONAL BENEFITS

ROCKET LAWYER

To take advantage of your new, free benefits, just follow these steps:

1. Go to: https://go.rocketlawyer.com/sendoso

2. Enter your work email address

3. You’ll receive an email from Rocket Lawyer; click the ‘Activate Account’ button

With Rocket Lawyer, you’ll have access to these services:

4. Fill out the form and you’re set!

● Legal Documents Library: Create and sign hundreds of legal documents such as wills, leases, and child care authorization forms ● Attorney Q&A: Submit a question and get reliable legal advice within one business day ● Attorney Phone Consultations: Schedule a free, 30-minute phone call with a Rocket Lawyer Attorney specializing in your issue ● Rocket Tax: File your taxeswith a CPA or EA for HALF OFF list prices. ● Rocket Sign: Instant online signatures on any document ● Rocket Evidence: Share video and picture evidence with an attorney for legal help on the go ● Attorney Discounts: Save up to 40% on lawyers in your area

Need help? Email us: benefitssuppo rt@rocketlawyer.com

Rocket Lawyer can help you with: Getting Married Landlord/ Tenant Issues

Estate Planning

Family/ ElderCare

Immigration Issues

Buyinga Home

Speeding Tickets

Starting a Family

ROCKET LAWYER

SENDOSO BENEFITS GUIDE

CLASSPASS

ClassPass allows employees to sign up for different fitness classes at a discounted rate High Intensity Interval Training, Yoga, Cryotherapy, Acupuncture, AND MANY MORE!

Classes are paid for with credits and there are 4 different plans available: ○ 12 Credits per month - $0/mo - FREE.

○ 28 Credits per month - $14/mo. ○ 46 Credits per month - $44/mo. ○ 96 Credits per month - $124/mo.

CLASSPASS I

SENDOSO BENEFITS GUIDE

FINANCIAL WELLNESS

The Benefits ofFinancial Wellness The goal of this kind of program is to help you move from astate of financial stress to astate of financial confidence. By providing you with access to educational tools, resources and professionals, the Morgan Stanley Financial Wellness Program can help you get started on the path to financial well-being today.

Visit your benefits intranet site to get started today on the path to financial wellness with the Morgan Stanley Financial Wellness Program. Togetstartedonthepathtofinancialwellness,registerforanaccount at https://login.morganstanleyclientserv.com/ux/finwell/sip/get-started in a few easy steps

financial education Deepen your financialknowledge through live and recorded sessions on essential money topics, delivered by financial professionals.

digital educationportal Measure and improve your financial well-being by exploring arange of topics, recommended based on your individual needs. The portal is designed to empower you with the informationto make better financial decisions.

financial consulting Consult with a Morgan Stanley

student loan resources Learn more about student loansand refinancing by logging into the the Financial Wellness Digital Portal for resources and education.

Financial Advisor to addressquestions specific to your financial situation. To sign up for acomplimentary consultation, log into the Financial Wellness Digital Portal and click “Looking for advice?” in the top right corner (if this is your first time logging in, you will be prompted to Take Your Financial Pulse).

FINANCIAL WELLNESS I

SENDOSO BENEFITS GUIDE

PET INSURANCE

PET INSURANCE I

SENDOSO BENEFITS GUIDE

COCOON

SENDOSO BENEFITS GUIDE

COCOON

LEGAL NOTICES

Health Insurance Portability and Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and security of certain individually identifiable health information, called protected health information (or PHI). You have certain rights with respect to your PHI, including a right to see or get a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy Practices, describing how your PHI may be used and disclosed and how you get access to the information, contact Human Resources. Women’s Health and Cancer Rights Act Enrollment Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Woman’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: 1. All stages of reconstruction of the breast on which mastectomy was performed. 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses. 3. Treatment of physical complications of the mastectomy, including lymphedema.

These will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this benefits plan. If you would like more information on WHCRA benefits, contact your plan administrator.

Newborns’ and Mothers’ Health Protection Act Disclosure Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Patient Protection Notice Your carrier generally may require the designation of a primary care provider. You have the right to designate any primary care provider who participates in your network and who is available to accept you or your family members. Until you make this designation, your carrier may designate one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the plan administrator. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from your carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in your network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the plan administrator.

SENDOSO BENEFITS GUIDE

LEGAL NOTICES I

LEGAL NOTICES

HIPAA Special Enrollment Notice If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy. To request special enrollment or to obtain more information about the plan's special enrollment provisions, contact the plan administrator.

SENDOSO BENEFITS GUIDE

LEGAL NOTICES I

LEGAL NOTICES

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2023. Contact your State for more information on eligibility –

ALABAMA-Medicaid

CALIFORNIA-Medicaid

Website: http://myalhipp.com/ Phone: 1-855-692-5447

Website: Health Insurance Premium Payment (HIPP) Program

http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov

ALASKA-Medicaid

COLORADO-Health First Colorado (Colorado’s Medicaid

Program) &ChildHealth Plan Plus (CHP+)

The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442

ARKANSAS-Medicaid

FLORIDA-Medicaid

Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery. c om/hipp/index.html Phone: 1-877-357-3268

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

SENDOSO BENEFITS GUIDE

LEGAL NOTICES I

LEGAL NOTICES

GEORGIA-Medicaid

MAINE-Medicaid

GA HIPP Website: https://medicaid.georgia.gov/health- insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party- liability/childrens- health-insurance-program-reauthorization- act-2009-chipra Phone: (678) 564-1162, Press 2

Enrollment Website: https://www.mymaineconnection.gov/benefits/s/?language= en_US Phone: 1-800-442-6003 TTY: Maine relay 711

Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms

Phone: -800-977-6740. TTY: Maine relay 711

INDIANA-Medicaid

MASSACHUSETTS-Medicaid and CHIP

Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584

IOWA-Medicaid and CHIP (Hawki)

MINNESOTA-Medicaid

Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to- z/hipp HIPP Phone: 1-888-346-9562

Website: https://mn.gov/dhs/people-we-serve/children-and- families/health- care/health-care-programs/programs-and- services/other- insurance.jsp Phone: 1-800-657-3739

KANSAS-Medicaid

MISSOURI-Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660

KENTUCKY-Medicaid

MONTANA-Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov

Kentucky Integrated Health Insurance Premium Payment Program (KI- HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms

LOUISIANA-Medicaid

NEBRASKA-Medicaid

Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178

Website: dhh.louisiana.gov/index.cfm/subhome/1/n/331 or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618- 5488 (LaHIPP)

SENDOSO BENEFITS GUIDE

LEGAL NOTICES I

LEGAL NOTICES

NEVADA-Medicaid

SOUTH CAROLINA-Medicaid

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

NEW HAMPSHIRE-Medicaid

SOUTH DAKOTA-Medicaid

Website: https://www.dhhs.nh.gov/programs-services/medicaid/health- insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218

Website: http://dss.sd.gov Phone: 1-888-828-0059

NEW JERSEY-Medicaid and CHIP

TEXAS-Medicaid

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIPPhone: 1-800-701-0710

Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493

NEW YORK-Medicaid

UTAH-Medicaid andCHIP

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

NORTH CAROLINA-Medicaid

VERMONT-Medicaid

Website:Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100

NORTH DAKOTA-Medicaid

VIRGINIA-Medicaid andCHIP

Website: https://coverva.dmas.virginia.gov/learn/premium- assistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/health- insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924

Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825

OKLAHOMA-Medicaid and CHIP

WASHINGTON-Medicaid

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

OREGON-Medicaid

WEST VIRGINIA-Medicaid and CHIP

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075

PENNSYLVANIA-Medicaid and CHIP

WISCONSIN-Medicaid andCHIP

Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP- Program.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437)

RHODE ISLAND-Medicaid and CHIP

WYOMING-Medicaid

Website: https://health.wyo.gov/healthcarefin/medicaid/programs- and-eligibility/ Phone: 1-800-251-1269

Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)

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To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565 PaperworkReduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately four minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210- 0137. OMB Control Number 1210-0137 (expires 1/31/2026)

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Genetic Information Nondiscrimination Act (GINA) Disclosures Genetic Information Nondiscrimination Act of 2008

The Genetic Information Nondiscrimination Act of 2008 (“GINA”) protects employees against discrimination based on their genetic information. Unless otherwise permitted, your Employer may not request or require any genetic information from you or your family members. The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

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USERRA Notice Your Rights Under USERRA A. The Uniformed Services Employment and Reemployment Rights Act

USERRA protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service or certain types of service in the National Disaster Medical System. USERRA also prohibits employers from discriminating against past and present members of the uniformed services, and applicants to the uniformed services. B. Reemployment Rights You have the right to be reemployed in your civilian job if you leave that job to perform service in the uniformed service and: • You ensure that your employer receives advance written or verbal notice of your service; • You have five years or less of cumulative service in the uniformed services while with that particular employer; • You return to work or apply for reemployment in a timely manner after conclusion of service; and • You have not been separated from service with a disqualifying discharge or under other than honorable conditions. If you are eligible to be reemployed, you must be restored to the job and benefits you would have attained if you had not been absent due to military service or, in some cases, a comparable job. C. Right to Be Free from Discrimination and Retaliation If you: • Are a past or present member of the uniformed service; • Have applied for membership in the uniformed service; or • Are obligated to serve in the uniformed service; then an employer may not deny you o Initial employment; o Reemployment; o Retention in employment; o Promotion; or o Any benefit of employment because of this status. In addition, an employer may not retaliate against anyone assisting in the enforcement of USERRA rights, including testifying or making a statement in connection with a proceeding under USERRA, even if that person has no service connection. D. Health Insurance Protection • If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. • Even if you do not elect to continue coverage during your military service, you have the right to be reinstated in your employer's health plan when you are reemployed, generally without any waiting periods or exclusions (e.g., pre-existing condition exclusions) except for service-connected illnesses or injuries.

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E. Enforcement • The U.S. Department of Labor, Veterans' Employment and Training Service (VETS) is authorized to investigate and resolve complaints of USERRA violations. For assistance in filing a complaint, or for any other information on USERRA, contact VETS at 1-866-4-USA-DOL or visit its Web site at http://www.dol.gov/vets. An interactive online USERRA Advisor can be viewed at http://www.dol.gov/elaws/userra.htm. • If you file a complaint with VETS and VETS is unable to resolve it, you may request that your case be referred to the Department of Justice or the Office of Special Counsel, as applicable, for representation. • You may also bypass the VETS process and bring a civil action against an employer for violations of USERRA. The rights listed here may vary depending on the circumstances. The text of this notice was prepared by VETS, and may be viewed on the Internet at this address: http://www.dol.gov/vets/programs/userra/poster.htm. Federal law requires employers to notify employees of their rights under USERRA, and employers may meet this requirement by displaying the text of this notice where they customarily place notices for employees. U.S. Department of Labor, Veterans' Employment and Training Service, 1-866-487-2365.

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COBRA

Model General Notice of COBRA Continuation Coverage Rights (For use by single-employer group health plans) ** Continuation Coverage Rights Under COBRA**

Introduction

You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct.

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COBRA

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

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COBRA

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the plan administrator.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

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COBRA

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov . Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period 1 to sign up for Medicare Part A or B, beginning on the earlier of • The month after your employment ends; or • The month after group health plan coverage based on current employment ends. If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage. If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare. For more information visit https://www.medicare.gov/medicare-and-you.

If you have questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/agencies/ebsa . (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov .

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COBRA

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

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1 https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods

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FAMILY MEDICAL LEAVE ACT (FMLA)

Family Medical Leave Act (FMLA) Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job-protected leave in a 12-month period for the following reasons: • The birth of a child or placement of a child for adoption or foster care; • To bond with a child (leave must be taken within one year of the child’s birth or placement); • To care for the employee’s spouse, child, or parent who has a qualifying serious health condition; • For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job; • For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse, child, or parent. An eligible employee who is a covered servicemember’s spouse, child, parent, or next of kin may also take up to 26 weeks of FMLA leave in a single 12-month period to care for the servicemember with a serious injury or illness.

Benefits & Protections

An employee does not need to use leave in one block. When it is medically necessary or otherwise permitted, employees may take leave intermittently or on a reduced schedule. Employees may choose, or an employer may require, use of accrued paid leave while taking FMLA leave. If an employee substitutes accrued paid leave for FMLA leave, the employee must comply with the employer’s normal paid leave policies.

While employees are on FMLA leave, employers must continue health insurance coverage as if the employees were not on leave.

Upon return from FMLA leave, most employees must be restored to the same job or one nearly identical to it with equivalent pay, benefits, and other employment terms and conditions. An employer may not interfere with an individual’s FMLA rights or retaliate against someone for using or trying to use FMLA leave, opposing any practice made unlawful by the FMLA, or being involved in any proceeding under or related to the FMLA.

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